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Abstract

Background: Depression is known to be prevalent in heart failure (HF) patients. However, little is known about the consequences of depressive symptoms for patient outcomes. We studied the independent relationship of depressive symptoms to readmission and mortality in a large sample of hospitalised HF patients.

Methods: A sample of 958 HF patients who where admitted to the hospital with symptoms of HF (NYHA II-IV) were prospectively followed. Data were collected on demographic and clinical characteristics. Depressive symptoms were measured at baseline by means of the Center for Epidemiologic Studies Depression Scale (CES-D). Cox proportional hazards regression analyses were used to examine the association of depressive symptom severity on the combined endpoint of readmission and mortality and on readmission and mortality separately, during 18 months follow up.

Results: At baseline 377 patients reported depressive symptoms (CES-D≥ 16), of whom 177 (18%) patients had moderate depressive symptoms (CES-D16 –23) and 200 (21%) patients had severe depressive symptoms (CES-D ≥ 24). Patients with severe depressive symptoms had a 31% higher risk of either readmission or death independent of age and sex, whereas patients with moderate or without depressive symptoms showed no higher risk. A similar high risk was found for readmission (all cause: HR 1.35, 95% CI 1.09 –1.67; HF: HR 1.37, 95% CI 1.01–1.86). Days in hospital during readmission was significant higher for patients with severe depressive symptoms compared to patients without depressive symptoms (p=<0.001). The association between patients with severe depressive symptoms and mortality as a separate endpoint, was less strong and not statistically significant (HR: 1.33, 95% CI 0.98 –1.80).

Conclusion Moderate and severe depressive symptoms are common in hospitalised HF patients. If patients reported severe depressive symptoms the chance of being readmitted was 35% higher compared to patients without depressive symptoms and the length of readmission was significantly higher.